tbuckley/cabot-search huggingface dataset:
Abstract 13576: Stereotactic Cardiac Radiotherapy Reduces Structural Heart Disease Associated Refractory Ventricular Tachycardia - A Metaanalysis
Authors: Nourhan Chaaban, Sagar Ranka, Cameron Carlson, Farhad Sami, David Akhavan, Seth H Sheldon, Madhu Reddy, Amit Noheria
Journal: Circulation (2022)

Introduction: Cardiac stereotactic body radiotherapy (SBRT) is a paradigm changing treatment for refractory ventricular tachycardia (VT) in patients with structural heart disease. We sought to review the effectiveness of SBRT reported in published studies. Hypothesis: There is a reduction in VT events after cardiac SBRT. Methods: We performed a comprehensive literature search in PubMed, Embase and Google Scholar including all studies on cardiac SBRT for VT till May 2022. Efficacy was evaluated as random-effects pooled rate ratios (RR) of VT episodes, antitachycardia pacing (ATP) therapies and implantable cardioverter-defibrillator (ICD) shocks post-SBRT (after 6-week blanking) vs. during 3-12 months pre-SBRT, with patients serving as their own controls. Results: We included 12 single-arm studies on cardiac SBRT (90 patients) published 2017-2022 with median follow-up ranging 6-28 months. The pooled RR of VT episodes, ATP therapies and ICD shocks post- vs. pre-SBRT were 0.11 (95% CI 0.06-0.21, p&lt;0.001), 0.09 (95% CI 0.04-0.20, p&lt;0.001), and 0.10 (95% CI 0.05-0.19, p&lt;0.001) as shown in Figure 1. There was significant heterogeneity in results (p&lt;0.00001 for all 3 endpoints). The combined 1- and 2-year overall patient survival was 69% and 56% respectively (Figure 2). Conclusions: Cardiac SBRT reduces recurrent VT episodes and ICD shocks in patients with VT refractory to medical therapy and catheter ablation. There is heterogeneity in results from different studies, likely related to differences in patient selection and treatment techniques. The overall patient survival in this high-risk population compares favorably to data from catheter ablation trials.
Abstract 13644: Hospitalization Outcomes for Patients With Heart Failure With Reduced Ejection Fraction and Iron Deficiency: Analysis of National Inpatient Sample
Authors: Raquel Soon-Shiong, Sadichhya Karki, Dennis Kumi, Prajwal Shrestha, Iriagbonse Asemota, Yaqi Zhang, CYRA-YOONSUN KANG, Ninos Nissan, Birju Patel
Journal: Circulation (2022)

Introduction: Iron deficiency (ID) is associated with worse exercise tolerance in patients with HFrEF regardless of hemoglobin level. Intravenous iron replacement in these patients increases functional capacity, improves quality of life, and reduces recurrent hospitalizations. We examined a large inpatient database to explore the relationship between ID without anemia and outcomes in HFrEF patients. Methods: We queried the National Inpatient Sample (2016-2018) for adults with HFrEF as the principal diagnosis and ID as a secondary diagnosis using ICD-10 codes. The primary outcome was inpatient mortality and secondary outcomes were length of stay, total hospital charges, combined supraventricular and ventricular tachycardia, and cardioversion. STATA software was used for analysis. Multivariate logistic and linear regression analyses were used accordingly to compare groups while adjusting for confounders. Results: Of 446,539 patients hospitalized with HFrEF, 0.16% had concomitant ID without anemia. There was no difference in mortality in HFrEF patients with ID compared to those without ID (2.8% vs 2.9%; aOR 0.97; p=0.94). Length of stay was significantly higher (8.0 vs 5.4 days; CI 0.46-4.5; p=0.02) and there was a non-significant increase in hospital charges ($80,292 vs $57,072; CI -$3,043-$39,821; p=0.09) for HFrEF patients with ID. Tachycardia occurred more frequently in HFrEF patients with ID (18.8% vs 10.3%; aOR 1.93; p=0.004), but there was no significant difference in cardioversion (1.39% vs 1.68%; aOR 0.82; p=0.78). Conclusions: We did not find an association between ID and inpatient mortality in HFrEF patients. Symptomatic improvement is an important factor for determining time of discharge in patients admitted for HFrEF and our analysis demonstrates significantly longer hospitalization in patients with ID. Further studies may elaborate on the effect of iron replacement on duration of hospitalization for patients admitted with HFrEF.
Abstract 13636: Persistent Acute Kidney Injury is Associated With Poor Outcomes and Increased Hospital Cost in Vascular Surgery
Authors: Sara Hensley, Amanda Filiberto, Esra Adiyeke, Tezcan Ozrazgat-Baslanti, Gilbert R Upchurch, Azra Bihorac, Michol Cooper
Journal: Circulation (2022)

Introduction: Postoperative acute kidney injury (AKI) is common after vascular surgery and is associated with increased morbidity and mortality. Hypothesis: It is hypothesized that patients with persistent postoperative AKI have increased complications, mortality and hospital cost. Methods: A single center retrospective cohort of patients undergoing non-emergent major vascular surgery (lower extremity bypass, endovascular and open aortic surgery), between 2014-2019 was analyzed. Development of postoperative AKI (defined as &gt; 50% or 0.3 mg/dl increase in serum creatinine relative to reference after surgery and before discharge) was evaluated. Patients were divided into 3 groups: no AKI, non-persistent AKI (&lt; 48 hours) and persistent AKI ( &gt; 48 hours). Multivariable regression analyses were then used to evaluate the association between AKI status and postoperative complications, 90-day mortality, and hospital cost. Results: A total of 1,881 patients undergoing 1,980 vascular procedures were included. Thirty five percent of patients developed postoperative AKI. Patients with persistent AKI were more likely to have longer ICU and hospital stays, as well as more mechanical ventilation days. In risk-adjusted logistic regression analysis, persistent AKI was a major predictor of 90-day mortality (OR 4.4, 95% CI 2.5-7.6). Risk-adjusted average cost was higher for patients with any type of AKI. The incremental cost of having any AKI ranged from $5,500-$12,400, even after adjustment for comorbidities and other postoperative complications. The risk-adjusted average cost for patients stratified by type of AKI was higher among patients with persistent AKI compared to those with no or non-persistent AKI (Fig.1). Conclusions: Persistent AKI after vascular surgery is associated with increased complications, mortality and cost. Strategies to prevent and aggressively treat AKI in the perioperative setting are imperative to optimize care for this population.
Abstract 13528: Sex Differences in Healthcare Resource Utilization in Patients With Atrial Fibrillation Receiving Dronedarone versus Sotalol Following Ablation
Authors: Emily P Zeitler, Dara Stein, RON PREBLICK, Shaum Kabadi, David MCKINDLEY, Jason Rashkin, Samuel Huse, Nicole Stamas, Michael H Kim
Journal: Circulation (2022)

Introduction: Patterns of anti-arrhythmic drug therapy for atrial fibrillation (AF) treatment and outcomes may differ by sex. Dronedarone has shown clinical benefit vs sotalol post-ablation in males and females with AF; however, the impact of these drugs on healthcare resource utilization (HCRU) remains unknown among sex subgroups. Methods: We conducted two retrospective, observational cohort analyses using IBM MarketScan® data (Jan 2012-Mar 2020) in adult male and female patients with AF who received dronedarone or sotalol post-ablation. Patients were required to have had 12 months’ available pre-ablation data; follow-up ended at the earliest of health-plan disenrollment, death or end of data availability (Dec 2020). Prevalence (per 100 patient-years [PY]) during the post-ablation period was calculated for all-cause HCRU (hospitalizations; emergency room [ER] visits; outpatient office visits; other outpatient services). Patients receiving sotalol were propensity score matched 1:1 to patients receiving dronedarone and outcomes were compared using univariate generalized linear models with Poisson distribution. Results: In females (n=460 per cohort ; age at ablation: ~64 years; mean follow-up: ~29 months; prior heart failure: ~14.6%; mean Charlson comorbidity index [CCI]: ~0.8), post-ablation prevalence of ER visits, outpatient office visits, and other outpatient services were significantly lower with dronedarone than sotalol (Table). In males (n=1112 per cohort; age at ablation: ~60 years; mean follow-up: ~29 months; prior heart failure: ~12%; mean CCI: ~0.8), post-ablation prevalence of hospitalizations was significantly lower with dronedarone than sotalol, but other HCRU measures were similar. Conclusions: In females post-AF ablation, dronedarone was generally associated with lower HCRU than sotalol. In males, dronedarone was associated with lower hospitalization prevalence than sotalol, but other HCRU was similar.
Abstract 13731: 30-Days Readmission Rate, Mortality and Health Care Burden Among Patients Who Underwent Transcatheter Mitral Valve Repair With Co-Existing Atrial Fibrillation
Authors: Michael Fatuyi, Ndausung Udongwo, tochukwu egbujiobi, Ali Horoub, Nadine El Hajj, Joseph Amoah, NESTA BANKEJESU, Fumilayo Williams-Idahagbon, Firas Ajam, Oluwasegun O Akinti, Daniel Kiss
Journal: Circulation (2022)

Introduction: Transcatheter mitral valve repair (TMVR) is a minimally invasive technique for the treatment of selected patients with symptomatic chronic moderate to severe mitral regurgitation (MR). Depending on the severity &amp; chronicity of MR, there is left atrium remodeling in response to the volume overload, which contributes to the generation of atrial fibrillation (AF). Our study aimed to examine the 30-day readmission rates (30-DRr) among patients who underwent TMVR with co-existing AF in the United States. Methods: Using the 2017 National Readmission Database, we conducted a retrospective analysis of patient discharges with TMVR as a principal diagnosis and co-existing AF as a secondary diagnosis according to ICD-10 codes. Readmission was defined as the first admission to any hospital for any non-trauma diagnosis within 30 days of the index discharge. The primary outcome was 30-DRr, while secondary outcomes were readmission mortality rate, most common diagnoses for readmission, length of stay, hospitalization costs &amp; patient charge. Results: A total of 3,242 Index admission with TMVR and AF; mean age 79.2years, &amp; 53.3% male. In-hospital mortality rate was 2.46%, while all-cause readmission rate was 12%. Among this group of readmitted patients, the in-hospital mortality rate increased to 5.66% (aOR 2.38, adjusted p-value=0.009). The total hospital days associated with readmission were 2,244 days, with a total healthcare in-hospital economic burden of $6.24 million and total patient charge of 27 million. The most common diagnoses for readmission were hypertensive heart and chronic kidney disease with heart failure, hypertensive heart heart failure, Sepsis, AKI, Non-rheumatic MR &amp;, AF, respectively. Conclusions: We observed among patient who underwent TMVR with co-existing AF, 1 in 8 was readmitted within 30-days with subsequent readmission associated with an increase in mortality and prolonged LOS, thus contributing to a significant economic burden.
Abstract 13286: Symptoms in Heart Failure Improve With More Intense Physical Activity
Authors: Jonathan Auld, Frances Elaine Thompson, April Stempien-Otero, Cynthia M Dougherty
Journal: Circulation (2022)

Purpose. RCTs have demonstrated the benefits of exercise in heart failure (HF) including improved functional status and quality of life, with fewer hospitalizations. Little is known about how changes in physical activity (PA) over time may influence physical and psychological symptoms. This study examined the extent to which changes in PA over time were associated with changes in physical and psychological symptoms in HF. Methods. A secondary analysis was conducted using an RCT of exercise in HF patients (N=86) who received an initial ICD. Data were collected at baseline and 2 months. Physical activity was measured over 5 consecutive days using the StepWatch PA Monitor (Orthocare Innovations TM ) for total PA (mean steps/day) and intensity (mean steps/min for most intense 30 minutes/day). Other measures included: physical symptoms (Patient Concerns Assessment (PCA); fatigue and pain (SF-36 Vitality &amp; Bodily Pain subscales, respectively), and symptoms of depression (Patient Health Questionnaire-9, PHQ9) and anxiety (State-Trait Anxiety Index, STAI). Multivariate regression was used to examine for associations between increased and decreased PA and changes in physical and psychological symptoms, adjusting for age, co-morbidities, body mass index, ejection fraction (EF), and study group. Results. Patients were male (82%), 55.3±12.1 years of age, white (79%), with multiple co-morbidities (Charlson Co-morbidity: 2.1±1.3), BMI of 30.0±5.1, with reduced EF (31.0±10.1%). An increase in PA intensity from baseline to 2 months was associated with significant improvement in psychological symptoms (PHQ9:β= -0.13, p=0.030; STAI:β= -0.26,p=0.026) and fatigue (β= 0.55,p=0.023). An increase in total PA (steps/day) was associated with improvement in anxiety only (β= -1.23, p=0.045). A decrease in PA (total and intensity) was not associated with changes in any symptoms. Conclusion. For patients with HF and an initial ICD, increased intensity of PA over 2 months was associated with improved psychological symptoms and reduced fatigue. Decreases in PA (total and intensity) were not associated with symptoms. These findings warrant further investigation as interventions focused on PA intensity rather than quantity may be more effective in reducing symptoms in HF.
Abstract 13544: A Naturally-Derived Spirulina Peptide Reduces the Deleterious Vascular Effects of Hyperglycemia Regulating the DPP-IV Activity and LPCAT1
Authors: Albino Carrizzo, Eduardo Sommella, Paola Di Pietro, Antonio Damato, Marina Sala, Eleonora Venturini, Pietro Campiglia, carmine vecchione
Journal: Circulation (2022)

Introduction: Recently, we showed that administration of SP6 was able to exert an antihypertensive effect by enhancing endothelial vasodilation by promoting increased serum nitrite levels. New computational data revealed that SP6 is able to interact with the dipeptidylpepdase IV (DPP-IV) enzyme prompting us to hypothesize its possible involvement in the control of diabetes mellitus. Hypothesis: This work aimed to investigate the anti-diabetic role of the peptide SP6 isolated from gastro-intestinal-simulated in vitro digestion of spirulina platensis matrix. Methods: We used an experimental mouse model of type 2 diabetes. A 4-week treatment by gavage administration of SP6 was performed. By molecular biology studies and the use of mass spectrometry imaging (MALDI-MSI), the expression of GLUTs levels, DPP-IV activity and GLP-1 levels, and oxidative stress were evaluated. Results: We were able to show that daily oral administration with SP6 peptide was able to protect against hyperglycemia-induced endothelial dysfunction. Moreover, SP6 in vivo treatment was able to regulate the expression levels of GLUT1, GUT2, GLUT4 and SGLT2. In parallel, SP6 treatment was able to inhibit DPP-IV activity by promoting an increase in circulating levels of glucagon-like-peptide 1 (GLP1). Measurement of glycated hemoglobin levels after a 5-week treatment period showed that peptide treatment was able to normalize HbA1c levels, bringing its levels back below 6% and to modulate lysophosphatidylcholine and Phosphatidylcholine levels. Conclusions: In conclusion, our data support the beneficial role of SP6 on the pathophysiology of diabetes and lay the foundation to develop a novel anti-diabetic strategy.
Abstract 13665: Determination of Lipid-Rich Plaque by Artificial Intelligence-Enabled Quantitative Computed Tomography Using Near-Infrared Spectroscopy
Authors: Hiroyuki Omori, Hitoshi Matsuo, James Earls, Yoshihiro Sobue, Shinichiro Fujimoto, Yui Nozaki, Gaku Nakazawa, Kuniaki Takahashi, Kazuhiro Osawa, Ryo Okubo, Umihiko Kaneko, Hideyuki Sato, Takashi Kajiya, Toru Miyoshi, Keishi Ichikawa, Mitsunori Abe, Toshiro Kitagawa, Hiroki Ikenaga, Mike Saji, Nobuo Iguchi, Takeshi Ijichi, Hiroshi Mikamo, Akira Kurata, Masao Moroi, raisuke iijima, Tami Crabtree, James K Min, Rine Nakanishi
Journal: Circulation (2022)

Introduction: By near-infrared spectroscopy (NIRS), plaques with 4-mm maximum lipid-core burden index (maxLCBI4 mm ) ≥400 are lipid-rich plaques. By CCTA, high-risk plaques are defined by presence of low-density non-calcified plaque (LD-NCP) and positive remodeling (PR) &gt;1.1. Hypothesis: Artificial intelligence-enabled quantitative CT (AI-QCT) will enable identification of lipid-rich plaques when compared to NIRS reference standard. Methods: 128 atherosclerotic plaques from 47 patients were prospectively enrolled. MaxLCBI 4mm (cutoff was defined as 400) and LD-NCP derived from AI-QCT (Cleerly LABS, Denver CO) were compared. We also analyzed vessel area, plaque burden, minimal lumen area and plaque length between intravascular ultrasound (IVUS) and AI-QCT. Results: Amongst 128 plaques evaluated, maxLCBI 4mm ≥400 was 26 plaques (20.3%). Use of current LD-NCP (&lt;30 Hounsfield threshold (HU) and LD-NCP volume &gt;0 mm 3 ) and PR ≥1.1, yielded a sensitivity, specificity, positive and negative predictive value and accuracy of 100%, 28%, 26%, 99%, and 43%. LD-NCP volume threshold was identified from AUC as 1.8 mm 3 . With LD-NCP volume ≥1.8 mm 3 , the performance of AI-QCT was improved to 92%, 87%, 65%, 98% and 88%, respectively (Figure 1). We noted very good to excellent correlation between AI-QCT and IVUS for vessel area (R2 =0.776), plaque burden (0.699), minimal lumen area (0.815) and plaque length (0.844). Conclusions: The current CCTA definition of NIRS-verified lipid-rich plaques has limited specificity and accuracy; use of a LD-NCP volume threshold, enabled only by AI-QCT, substantially improves performance for detection and characterization.
Abstract 13641: Feasibility of Same-Day Discharge After Uncomplicated Transvenous Lead Extraction
Authors: Mohanad Elchouemi, Rami Helmy, Carola Gianni, Lauryn Spinetta, Robert C Neely, Issa Asfour, Sanghamitra Mohanty, Domenico G Della Rocca, Akash P Patel, Mohamed A Bassiouny, Paul C Coffeen, Patrick M Hranitzky, Andrea Natale, Robert C Canby, Amin Al-Ahmad
Journal: Circulation (2022)

Introduction: Transvenous lead extraction (TLE), while mostly a safe procedure, has risk of serious periprocedural complications. As such, overnight hospitalization remains a routine practice. Same-day discharge (SDD) may be considered in uncomplicated TLE. Herein, we sought evaluate the safety of SDD. Methods: This is a retrospective analysis of 89 consecutive pts who underwent TLE in our center from January through December 2020. SDD patients were compared those with longer hospital stay (non-SDD) with respect to clinical and procedural characteristics. The safety endpoint was incidence of re-hospitalization/death at 30-days. Results: 51 patients had SDD after TLE and 38 had non-SDD (median length of stay, 2 days IQR 1-5). 38% were female, with a mean age of 67±14 years and BMI of 27.9±7.4 Kg/m 2 . The main indication for TLE was malfunction for SDD vs infection for non-SDD (figure). Clinical characteristics were comparable, with a trend for a higher rate of co-morbidities predisposing to infection for non-SDD (figure). As expected, SDD patients had fewer leads to extract (1.5±0.6 vs 2.1±1.1; p=0.003), albeit with a similar dwelling time (105±65 months vs 114±70 months), and shorter procedural times (90±47 min vs 125±87 min; p=0.01). Of note, laser was used as an adjunct extraction tool at a comparable rate (75% vs 76%). There was no significant difference in the safety endpoint (8% SDD vs 3% non-SDD; p=ns), with 1 post-procedural death (pulmonary embolism) in the non-SDD group, and 4 re-hospitalizations in the SDD group: 1 for evacuation of a pocket hematoma, 1 for drainage of a late symptomatic pericardial effusion secondary to pericarditis, 1 for lead revision. Conclusions: SDD discharge following uncomplicated TLE in selected patients is feasible, with an acceptable safety profile with respect to 30-days clinical outcomes.
Abstract 13385: Long Term Outcomes in Catheter Ablation of Atrial Fibrillation Compared to Medical Therapy
Authors: Yong Giun Kim, Sunjidatul Islam, Doug Dover, Marc Deyell, Nathaniel Hawkins, Roopinder Sandhu, Jon Sapp, Jason Andrade, Padma Kaul, Ratika Parkash
Journal: Circulation (2022)

Introduction: The long-term effects of catheter ablation (CA) compared to medical therapy on cardiovascular outcomes for atrial fibrillation (AF) remain undetermined. We examined the outcomes associated with CA compared to rate or rhythm control therapy in a population cohort with AF. Methods: Using Alberta administrative data, patients with AF as the primary diagnosis during hospitalization or emergency department/physician visit were included between 2008-2018. Based on therapy received, patients were assigned to CA, rate (digoxin, calcium channel or beta blocker) or rhythm control (amiodarone, sotalol, flecainide, propafenone, dronedarone). If treatment changed over time, the patient was censored in the prior treatment arm and assigned to the new arm. The association of treatment (included as time-varying covariate) with the primary composite outcome of death, hospitalization for heart failure or stroke was examined using multivariable Cox models after adjusting for age, sex, comorbidities and baseline medications. Secondary outcomes included cardiovascular hospitalizations, and individual components of the composite. Results: There were 2,149 (4.0%) patients treated with CA and 51,315 with medical treatment (rate : 41,948, (81.5%) rhythm: 9,367 (18.2%). During a median follow-up of 4.2 years, CA for AF was associated with a lower crude incidence of the composite outcome (rate per 100 person-years was 3.3 for CA, 9.5 for rate control, and 6.3 for rhythm control). In multivariate analysis, compared to CA, both rate (adjusted hazard ratio (aHR) 1.55, 95% confidence interval (CI), 1.44 to 1.68) and rhythm control (aHR 1.37; 95% CI 1.27 to 1.49) were associated with a higher risk of the primary composite outcome.(Figure) Secondary outcomes are shown in the Figure. Conclusions: Only a small percentage of patients with AF undergo CA. Patients selected for CA have a lower risk of long-term adverse outcomes compared to medical therapy in patients with AF.